Health inspection·August 16, 2024

F 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals. Based on review of facility policy and clinical records, and staff interview, it was determined that the facility failed to review and revise comprehensive care plans to reflect the current care and services for three of 26 residents reviewed (Residents R27, R88, and R100). Findings include: A facility policy entitled, Care Plans, plans of service dated 7/2024, indicated Care plans are updated whenever a change is necessitated by a resident's change in condition, physician orders, or when scheduled by the MDS (Minimum Data Set- standardized assessment tool that measures health status in nursing home residents) team for a quarterly, change in condition, or annual review. Resident R27's clinical record revealed an admission date of 5/26/21, with diagnoses that included hypothyroidism (a condition when the thyroid produces low amounts of thyroid hormones), and diabetes (a health condition that caused by the body's inability to produce enough insulin). Resident R27's clinical record revealed the last care plan meeting note was dated 5/9/24. Resident R27's care plan revealed a goal date of 8/7/24, indicating that the care plan had not been reviewed and revised to reflect the current care and services. Resident R88's clinical record revealed an admission date of 5/5/23, with diagnoses that included diabetes and hypertension (high blood pressure). Resident R88's clinical record revealed a late entry for the last care plan meeting note dated 8/15/24. Resident R88's care plan revealed a goal date of 7/25/24, indicating that the care plan had not been reviewed and revised to reflect the current care and services. Resident R100's clinical record revealed an admission date of 3/24/21, with diagnoses that included dysphagia (trouble swallowing), difficulty in walking, and muscle weakness. Resident R100's clinical record revealed the last care plan note was a late entry dated 5/10/24, for a 5/03/24 care plan meeting. Resident R100's care plan revealed a goal date of 8/1/24, indicating that the care plan had not been reviewed and revised to reflect the current care and services. (continued on next page) Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE FORM CMS-2567 (02/99) Previous Versions Obsolete Facility ID: If continuation sheet Page 1 of 6 Event ID: 395292 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 395292 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/16/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wesbury United Methodist Commu 31 North Park Ave Ext Meadville, PA 16335 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)